Method and apparatus for meniscal repair

ABSTRACT

An anchor for securing suture to tissue, the anchor comprising:
         an elongated body having a distal end and a proximal end, the distal end having a distal slot extending proximally into the elongated body, and the proximal end having a proximal slot extending distally into the body;   the distal slot comprising a wide section and a narrow section, wherein the wide section has a width such that the suture is slidably accommodated therein and the narrow section has a width such that the suture is bound therein, and further wherein the wide section is disposed distally of the narrow section.

This patent application claims benefit of:

-   (i) prior U.S. Provisional Patent Application Ser. No. 61/072,683,    filed Apr. 2, 2008 by David Caborn et al. for MENISCAL REPAIR    MAGAZINE CONCEPT;-   (ii) prior U.S. Provisional Patent Application Ser. No. 61/135,149,    filed Jul. 17, 2008 by David Caborn et al. for MENISCAL REPAIR    PROVISIONAL 3; and-   (iii) prior U.S. Provisional Patent Application Ser. No. 61/208,294,    filed Feb. 23, 2009 by Vincent Novak et al. for MENISCAL REPAIR    PROVISIONAL 4.

The three above-identified patent applications are hereby incorporatedherein by reference.

FIELD OF THE INVENTION

This invention relates to surgical methods and apparatus in general, andmore particularly to surgical methods and apparatus for the repair ofthe meniscus.

BACKGROUND OF THE INVENTION

The meniscus is a piece of cartilage located within the knee joint,between the top of the tibia and the bottom of the femur. The meniscusserves to facilitate stable movement of the tibia and femur relative toone another, and to absorb shock and to spread load.

The meniscus is frequently damaged (e.g., torn) as the result of injuryand/or accident. A damaged meniscus can impede proper motion of the kneejoint and cause pain, among other problems.

More particularly, the essential role of an intact meniscus, and itsimportance for proper knee function, has been well documented andaccepted by the general orthopedic community. An intact and functioningmeniscus is critical to optimally distribute weightbearing forces thattransfer through the knee joint while maintaining knee stability. Themeniscus is also vital to preserving the articular cartilage surfaces ofthe knee. Loss of meniscal tissue is considered to be a key precursor tothe development of knee osteoarthritis.

A major challenge in repairing a torn meniscus is the fact that thetissue itself is a fibrous structure that is not uniformly vascular. Thevascular zones of the meniscus comprise about one third of the meniscustissue and are generally recognized as the “red-red” and “red-white”zones. The red-red zone (i.e., the most highly vascularized portion ofthe meniscus) is an area in which meniscal repairs are known to healeasily and is located along its outer periphery. The red-white zoneextends from the most vascular area towards the inner portions of themeniscus where the blood supply eventually declines to non-vasculartissue (which is sometimes referred to as the “white-white” zone). It isbelieved that proper surgical technique is of great importance if asuccessful repair is to be achieved in the red-white zone. It isgenerally accepted knowledge that about 15% of all meniscal tears occurin the red-red zone, another 15% of meniscal tears occur in thered-white zone, and the remaining 70% of meniscal tears occur in thewhite-white (or non-vascularized) zone of the meniscus.

Another significant challenge in repairing a torn meniscus is that thesize and shape of the tears vary, making the reduction and apposition ofthe torn tissue difficult to accomplish. Without proper apposition andstability, torn meniscal tissue will not heal properly.

The art of repairing torn meniscal tissue was first developed andpioneered throughout the 1980's by early sports medicine-focusedsurgeons. The earliest methods employed only suture in the repair. Thetechniques of “inside-out” and “outside-in” suturing became theso-called “gold standard” for the repair of meniscal tissue. Both ofthese techniques focused on passing small diameter suture (size 2-0 or3-0) through the meniscus, reducing and closing the tear, and then tyinga suture knot over the knee capsule so as to fixate and stabilize thetear. A feature of these early all-suture repairs was that the surfaceof the meniscus was kept relatively smooth since the suture knot wasoutside of the knee joint, and the use of a needle and suture allowedthe surgeon a great deal of flexibility in adequately reducing andstabilizing the tear. Eventually, these early surgeons began concomitantuse of complementary techniques to promote a vascular response in themore non-vascular areas of the meniscus. Methods such as tear edge andmeniscapsular rasping, the application of an interpositional blood clot,trephination to create a vascular channel, and fascial sheath orsynovial flap coverage have been shown in several studies to be 150%more effective in healing a torn meniscus when compared to repairs thatdo not use such concomitant techniques.

The specific issues and challenges associated with the aforementionedall-suture inside-out and outside-in repair techniques are centeredprimarily on issues relating to the “user interface” and to the“tethering” of the meniscus to the knee capsule. More particularly, the“user interface” issues generally relate to the technical demandsrequired in the operating room: the skill of the surgeon and the numberof assistants required to safely pass the needle and suture from theanterior portion of the meniscus through the posterior portion of themeniscus and exit out through the posterior/medial aspect of the kneejoint (i.e., the so-called “inside-out” technique); or the passing of aneedle and suture from the medial aspect of the exterior of the kneeinto the knee joint, through the meniscus, the retrieval andre-insertion back into the meniscus, and then passage back out throughthe capsule to the medial aspect of the knee (i.e., the so-called“outside-in” technique). The aforementioned tethering issues relate tomore recent concerns about fixating suture over the knee capsule andthereby “tethering” the meniscus to the knee capsule, since evidencesuggests that such tethering of the meniscus to the knee capsule mayinterfere with the normal biomechanics of the meniscus (e.g., load andforce distribution, etc.).

As recognition of the importance of the meniscus grew in the late1980's, new methods of meniscus repair were developed. These new methodsfocused on improving execution of the procedure in order to make iteasier, simpler and faster to accomplish. The new gold standard approachbecame the so-called “all-inside” technique. The all-inside technique isintended to not violate the knee capsule or require any incisions on theposterior/medial aspects of the knee (i.e., such as is required with theinside-out and outside-in suturing techniques discussed above). With theall-inside technique, the entire repair—both approximation andfixation—is performed intra-articularly.

The first all-inside repair devices were tack-like implants that wereinserted through a standard arthroscopic portal and then forcefullypushed through the meniscus, crossing through the tear, thereby closingand fixing the tear without the use of suture. These tack-like implantswere formed out of biomaterials such as PLA, PLLA or PGA that wereexpected to biodegrade over time. However, these materials are quitehard when first inserted and, in use, were found to degrade or bioabsorbmuch more slowly than anticipated. Clinical use and follow-up havedemonstrated the inherent risks associated with the use of tack-likeimplants within the knee joint, as numerous published studies havereported device failure which can lead to tear reformation, looseimplants within the knee joint and articular cartilage damage.Furthermore, it can be challenging for the surgeon to adequately addressvarious tear shapes and sizes using these tack-like implants.

As a result, attention has returned to suture-based repairs, with a newfocus on performing a suture-based repair using an all-inside technique.There are several recent systems that seek to accomplish this goal.However, none of these systems have been found to be completelysatisfactory.

Thus, there is a need for a new and improved method and apparatus formeniscal repair.

SUMMARY OF THE INVENTION

The present invention provides a new and improved method and apparatusfor meniscal repair.

In one form of the present invention, there is provided an anchor forsecuring suture to tissue, the anchor comprising:

an elongated body having a distal end and a proximal end, the distal endhaving a distal slot extending proximally into the elongated body, andthe proximal end having a proximal slot extending distally into thebody;

the distal slot comprising a wide section and a narrow section, whereinthe wide section has a width such that the suture is slidablyaccommodated therein and the narrow section has a width such that thesuture is bound therein, and further wherein the wide section isdisposed distally of the narrow section.

In another form of the present invention, there is provided a systemcomprising:

a suture;

at least one anchor, the anchor comprising:

-   -   an elongated body having a distal end and a proximal end, the        distal end having a distal slot extending proximally into the        elongated body, and the proximal end having a proximal slot        extending distally into the body;    -   the distal slot comprising a wide section and a narrow section,        wherein the wide section has a width such that the suture is        slidably accommodated therein and the narrow section has a width        such that the suture is bound therein, and further wherein the        wide section is disposed distally of the narrow section;

wherein the suture is initially disposed within the wide section of thedistal slot of the at least one anchor so that the suture is slidablerelative to the at least one anchor.

In another form of the present invention, there is provided a method forsecuring a first element to a second element, the method comprising thesteps of:

providing a system comprising:

-   -   a suture;    -   at least two anchors, each anchor comprising:        -   an elongated body having a distal end and a proximal end,            the distal end having a distal slot extending proximally            into the elongated body, and the proximal end having a            proximal slot extending distally into the body;        -   the distal slot comprising a wide section and a narrow            section, wherein the wide section has a width such that the            suture is slidably accommodated therein and the narrow            section has a width such that the suture is bound therein,            and further wherein the wide section is disposed distally of            the narrow section;    -   wherein the suture is initially disposed within the wide section        of the distal slot of each of the at least two anchors so that        the suture is slidable relative to the at least two anchors; and

an inserter, the inserter comprising a hollow elongated shaft having asharp point disposed eccentric to the longitudinal axis of the hollowelongated shaft, and further wherein the suture and the at least twoanchors are disposed within the lumen of the hollow elongated shaft;

passing the inserter through the first object and the second object sothat the sharp point of the inserter resides on the far side of thesecond object;

ejecting the first anchor on the far side of the second object;

tensioning the suture so that the suture is drawn into the narrowsection of the distal slot of the first anchor, whereby to bind thesuture to the first anchor;

withdrawing the inserter out of the first object and the second object;

moving the inserter laterally;

passing the inserter back through the first object and the second objectso that the sharp point of the inserter resides on the far side of thesecond object;

ejecting the second anchor on the far side of the second object;

tensioning the suture, and withdrawing the inserter out of the firstobject and the second object, so that the suture is drawn into thenarrow section of the distal slot of the second anchor, whereby to bindthe suture to the second anchor.

In another form of the present invention, there is provided a system forsecuring suture to tissue, the system comprising:

an anchor, the anchor comprising:

-   -   an elongated body having a distal end and a proximal end, the        distal end having a distal slot extending proximally into the        elongated body;    -   the distal slot comprising a wide section and a narrow section,        wherein the wide section has a width such that the suture is        slidably accommodated therein and the narrow section has a width        such that the suture is bound therein, and further wherein the        wide section is disposed distally of the narrow section.

In another form of the present invention, there is provided a method forsecuring a first object to a second object, the method comprising thesteps of:

passing a first anchor having a strand of suture slidably mountedthereto through the first object and the second object at a firstlocation;

securing the strand of suture to the first anchor;

passing a second anchor having the strand of suture slidably mountedthereto through the first object and the second object at a secondlocation; and

securing the strand of suture to the second anchor under tension.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other objects and features of the present invention will bemore fully disclosed or rendered obvious by the following detaileddescription of the invention, which is to be considered together withthe accompanying drawings wherein like numbers refer to like parts, andfurther wherein:

FIGS. 1-3 are schematic views showing a meniscal repair system formed inaccordance with the present invention;

FIGS. 3A and 3B are schematic views showing the distal end of themeniscal repair system shown in FIGS. 1-3;

FIGS. 4-10 are schematic views showing further details of an anchor ofthe meniscal repair system shown in FIGS. 1-3;

FIG. 11 is a schematic view showing a meniscal repair effected using thesystem shown in FIGS. 1-3;

FIGS. 12-17 are schematic views showing an anchor being deployed from aninserter;

FIG. 18 is another schematic view showing a meniscal repair effectedusing the system shown in FIGS. 1-3;

FIG. 19 is still another schematic view showing a meniscal repaireffected using the system shown in FIGS. 1-3;

FIGS. 20-22 are schematic views showing how the suture may be twisted soas to enhance the holding strength of the meniscal repair system; and

FIGS. 23 and 24 are schematic views showing an alternative anchor formedin accordance with the present invention.

DETAILED DESCRIPTION OF THE INVENTION

Looking first at FIGS. 1-3, 3A and 3B, there is shown a novel system 5for meniscal repair. System 5 generally comprises a plurality of anchors10, a length of suture 15 and an inserter 20.

Anchors 10 are shown in greater detail in FIGS. 4-10. Each of theanchors 10 generally comprises an elongated body 25 which, in itspreferred construction, is generally cylindrical so that it can make aclose sliding fit within the lumen of a hollow delivery needle, as willhereinafter be discussed in further detail. Elongated body 25 ischaracterized by a distal end 30 and a proximal end 35.

On a “top” side of elongated body 25, a distal slot 40 extendsproximally along the elongated body, with distal slot 40 comprising awide section 45 and a narrow section 50. Also on the “top” side ofelongated body 25, a proximal slot 55 extends distally along theelongated body, with proximal slot 55 comprising a wide section 60 and anarrow section 65. Distal slot 40 is aligned with proximal slot 55.Preferably narrow section 50 of distal slot 40 is narrower than narrowsection 65 of proximal slot 55 (FIG. 5), and preferably wide section 45of distal slot 40 is the same width as wide section 60 of proximal slot55. Thus it will be seen that narrow section 50 of distal slot 40 isnarrower than narrow section 65, which is itself narrower than the widesection 45 of distal slot 40 and wide section 60 of proximal slot 55.Furthermore, the aforementioned narrow section 50, narrow section 65,wide section 45 and wide section 60 are sized relative to suture 15 sothat: (i) suture 15 will make a tight binding fit with narrow section 50of distal slot 40, (ii) suture 15 will make a sliding fit with narrowsection 65 of proximal slot 55, and (iii) suture 15 will move easilythrough wide section 45 of distal slot 40 and wide section 60 ofproximal slot 55. A wall 70 separates narrow section 50 of distal slot40 from narrow section 65 of proximal slot 55.

On a “bottom” side of elongated body 25 (i.e., on the side diametricallyopposed to the aforementioned “top” side of elongated body 25), a recess75 (FIGS. 6 and 7) extends into elongated body 25. Thus, recess 75 isdiametrically opposed to the aforementioned distal slot 40 and proximalslot 55. Recess 75 is formed long enough, and deep enough, so that itcommunicates with narrow section 50 of distal slot 40 and with a portionof wide section 45 of distal slot 40, and it communicates with narrowsection 65 of proximal slot 55 and with a portion of wide section 60 ofproximal slot 55 (FIG. 7). Recess 75 is significantly wider than suture15, so that suture 15 can move easily through recess 75.

On account of the foregoing construction, wide section 45 of distal slot40, narrow section 50 of distal slot 40, recess 75, wide section 60 ofproximal slot 55 and narrow section 65 of proximal slot 55 provide asuture pathway about elongated body 25 of anchor 10. Furthermore, and aswill hereinafter be discussed in further detail, on account of thedisposition and sizing of the aforementioned wide section 45, narrowsection 50, recess 75, wide section 60 and narrow section 65, anchor 10can be slidably mounted on the suture and then selectively secured tothe suture.

A fin 80 extends “downwardly” out of the “bottom” side of elongated body25. Fin 80 is aligned with recess 75 and diametrically opposed to distalslot 40 and proximal slot 55.

It should be appreciated that, while elongated body 25 is preferablygenerally cylindrical, it is also preferably not tubular: at no pointalong its length does elongated body 25 have a complete outer peripherywith a hollow interior.

Suture 15 may comprise any suture material of the sort known in the art.By way of example but not limitation, suture 15 may comprise braidedsuture, so-called “monofilament” suture, etc., and may be formed so asto be either “permanent” or absorbable. In one preferred form of theinvention, suture 15 comprises braided suture.

As will hereinafter be discussed in further detail, suture 15 isintended to be passed through anchor 10 (or, stated another way, anchor10 is intended to be “strung” onto suture 15) by passing the suturethrough distal slot 40, into and along bottom recess 75, and backthrough proximal slot 55 (see FIGS. 14-16, 20, etc.). In this respect itwill be appreciated that wide section 45 of distal slot 40, recess 75and wide section 60 of proximal slot 55 are all sized sufficiently widerelative to suture 15 such that suture 15 can slide easily through thoseopenings. Thus, so long as suture 15 remains disposed in those openings,suture 15 will be free to move easily through anchor 10 (and,correspondingly, anchor 10 will be free to slide easily along suture15). However, and as will hereinafter be discussed in further detail,when suture 15 is directed into narrow section 50 of distal slot 40, atight interference fit will be created between the anchor and thesuture, thereby securing the anchor and suture to one another.

As will also hereinafter be discussed in further detail, a plurality ofanchors 10 may be “strung” on a single suture 15 (see FIGS. 2, 13, 15,20, etc.). As noted above, when suture 15 passes through wide section 45of distal slot 40, recess 75 and wide section 60 of proximal slot 55 ofeach anchor 10, the anchors may be advanced along the suture. However,and as will hereinafter be discussed in further detail, when suture 15is directed into narrow section 50 of distal slot 40 of an anchor, atight interference fit will be created between that anchor and thesuture, thereby securing that anchor and the suture to one another.Significantly, and as will hereinafter be discussed in further detail,when a plurality of anchors 10 are slidably mounted on a single suture15, each of the anchors 10 may be selectively and individually securedto the suture when and where desired by the user.

Looking again at FIGS. 1-3, 3A and 3B, inserter 20 generally comprisesan elongated shaft 85 having a central lumen 90 extending therethrough.Elongated shaft 85 terminates in a sharp point 95 at its distal end.Sharp point 95 is created by forming an oblique face 96 (FIGS. 3A, 3Band 12) on the distal end of the elongated shaft, such that a section 97of elongated shaft 85 is exposed at the mouth of lumen 90. A handle 100(FIGS. 1-3) is secured to elongated shaft 85 at its proximal end. A slot105 (FIG. 13) is formed in elongated shaft 85 on its “bottom” side. Slot105 extends into exposed section 97 (FIGS. 12 and 13) of elongated shaft85. A small projection 106 (FIGS. 13 and 15) extends into slot 105.

As seen in FIGS. 2, 3A, 3B and 13, elongated shaft 85 is sized toreceive a plurality of anchors 10 therein, with those anchors being“strung” on a single suture 15. To this end, lumen 90 of elongated shaft85 is sized to slidably receive elongated bodies 25 of anchors 10, withfins 80 extending out through slot 105 of elongated shaft 85. Fins 80and slot 105 cooperate to keep anchors 10 aligned within lumen 90 ofelongated shaft 85. The aforementioned small projection 106 providesnominal resistance to the passage of fins 80 through slot 105. Smallprojection 106 is positioned such that the lead anchor 10 in lumen 90normally does not exit the distal end of the elongated shaft; however,with the application of a distally-directed force, fin 80 can slip pastsmall projection 106 so as to release the lead anchor from lumen 90.

Preferably, handle 100 includes a lever 110 for selectively advancing adrive shaft 115 along lumen 90 of elongated shaft 85, whereby toselectively advance anchors 10 along lumen 90 and thereby eject anchors10 one at a time from the distal end of elongated shaft 85. Handle 100preferably also includes a tension wheel 120 for selectively tensioningthe suture emerging from the proximal-most anchor 10 which is held inlumen 90 of elongated shaft 85. To this end, drive shaft 115 ispreferably hollow so that suture 15 can extend from the proximal-mostanchor 10, through the drive shaft and be engaged by tension wheel 120.

As seen in FIG. 11, system 5 may be used to close a tear 125 in ameniscus 130 using a plurality of anchors 10 and a suture 15. Moreparticularly, and looking now at FIGS. 11-18, sharp point 95 of inserter20 is advanced into meniscus 130, across tear 125, and then out the farside of meniscus 130. Then the leading anchor 10 in lumen 90 (i.e.,anchor 10A in FIG. 18) is ejected from elongated shaft 85. This is doneby advancing drive shaft 115 (e.g., with lever 110) so that the leadinganchor 10 has its fin 80 forced past small projection 106 in slot 105,whereby to release the anchor from the inserter. As the leading anchor10 is ejected from lumen 90, suture 15 initially resides in wide section45 of distal slot 40. However, by holding suture 15 under tension asanchor 10 is forced out of lumen 90 by drive shaft 115, anchor 10 isturned (i.e., away from exposed section 97 of elongated shaft 85) andsuture 15 is forced into narrow section 50 of distal slot 40, whereby tosecure suture 15 to anchor 10 in a cleating action. At the same time,another portion of suture 15 advances from wide section 60 of proximalslot 55 into narrow section 65 of proximal slot 55. Thus, at this pointsuture 15 will extend through narrow section 50 of distal slot 40,recess 75 and narrow section 65 of proximal slot 55, with the suturebeing secured to the anchor by virtue of the tight binding fitestablished between narrow section 50 of distal slot 40 and suture 15.

Then, while keeping suture 15 under tension so that anchor 10 remainspositioned against the far side of meniscus 130, inserter 20 iswithdrawn back across the meniscus, moved laterally by an appropriatedistance, re-inserted across tear 125, passed out the far side ofmeniscus 130, and another anchor 10 (i.e., anchor 10B in FIG. 18) isdeployed. Again, suture 15 is held under tension as the second anchor isdeployed on the far side of the meniscus so that anchor 10 is turned(i.e., away from exposed section 97 of elongated shaft 85) and suture 15is forced into the narrow section 50 of the distal slot 40 of thatsecond anchor, whereby to secure that second anchor in a cleatingaction. Again, as this occurs, another portion of suture 15 advancesfrom wide section 60 of proximal slot 55 into narrow section 65 ofproximal slot 55. Thus, at this point suture 15 will extend throughnarrow section 50 of distal slot 40, recess 75 and narrow section 65 ofproximal slot 55, with the suture being secured to the anchor by virtueof the tight binding fit established between narrow section 50 of distalslot 40 and suture 15.

Thus, the suture length extending between the first-deployed anchor(i.e., anchor 10A in FIG. 18) and the second-deployed anchor (i.e.,anchor 10B in FIG. 18) is maintained under tension so as to hold tear125 closed.

This operation may thereafter be repeated as many times as is necessaryin order to close the tear. See, for example, FIG. 19, where six anchors10, all connected by a single suture 15, are used to close a tear in themeniscus using a complex running stitch. This ability to set a variablenumber of anchors in the repair procedure, limited only by the number ofanchors held in inserter 20, is a significant advance in the art.

If desired, a small knot may be formed in the suture after placement ofthe last anchor for added holding strength. However, it should beappreciated that this knotting step is purely optional and not required.

It will be appreciated that, since anchors 10 are turned away fromexposed section 97 of elongated shaft 85 during deployment, thedisposition of elongated shaft 85 can largely regulate the dispositionof anchors 10 relative to the meniscus. Thus, where exposed section 97of elongated shaft 85 is oriented so that it is in the “6 o'clock” or“12 o'clock” position, the anchor will be set against the meniscus witha vertical disposition. Correspondingly, where exposed section 97 ofelongated shaft 85 is oriented so that it is in the “3 o'clock” or “9o'clock” position, the anchor will be set with a horizontal disposition(e.g., in the manner shown in FIGS. 11 and 18). Of course, in somesituations it may be possible to thereafter adjust the disposition of ananchor 10 against the meniscus, e.g., by using a grasper to manuallyturn the anchor.

In one preferred form of the invention, the first anchor 10 in inserter20 may have suture 15 permanently secured thereto, e.g., prior toinsertion of the inserter into the meniscus. By way of example but notlimitation, suture 15 may be glued, welded or otherwise secured to firstanchor 10. Furthermore, where suture 15 is so secured to first anchor10, the terminated suture may terminate substantially within the anchoror it may extend out of the anchor, as desired.

Significantly, since suture 15 is secured to each deployed anchor, thefailure of any one suture stitch does not threaten the integrity of theremainder of the repair. Indeed, if a suture stitch were to fail (e.g.,break), it would not disrupt the intact stitches in the remainder of therepair. The removed anchor could then be replaced by two or moreadditional anchors so as to reinforce the repair.

It will be appreciated that the holding power of each anchor 10 onsuture 15 is a function of the cleating action provided by that anchoron suture 15. It will also be appreciated that this cleating action islargely a function of the binding interference fit which is establishedbetween the suture and narrow section 50 of distal slot 40, since thesuture makes a loose fit through recess 75 and a sliding fit with narrowsection 65 of proximal slot 55. In practice, it has been found thatapproximately 35 Newtons of holding strength can be provided withoutreducing the width of narrow section 50 of distal slot 40 to the pointwhere it becomes excessively difficult to insert the suture into narrowsection 50 and/or where the act of insertion causes damage to thesuture. In the great majority of cases, a holding strength ofapproximately 35 Newtons has been found to be more than adequate formeniscal repair.

However, it has also been discovered that, to the extent that it isdesired to provide even greater holding strength to the system, suture15 can be twisted on itself during deployment so as to achieve holdingstrength of up to 75 Newtons without requiring any change to thediameter of narrow section 50 of distal slot 40. More particularly, andlooking now at FIGS. 20-22, sharp point 95 of inserter 20 is advancedinto meniscus 130, across tear 125, and then out the far side ofmeniscus 130. Then, with suture 15 in a relaxed condition, a firstanchor 10A is ejected from lumen 90 of inserter 20 so that the firstanchor 10A sits on the far side of the meniscus. As this occurs, firstanchor 10A will tend to turn as it exits lumen 90, but suture 15 willtend to stay in wide section 45 of distal slot 40 and not enter narrowsection 50 of distal slot 40. Thus, at this point, suture 15 is stillrelatively free to slide relative to first anchor 10A. With suture 15still in a relaxed condition, inserter 20 is then withdrawn frommeniscus 130, moved laterally, re-inserted across tear 125 and passedout the far side of meniscus 130. Then elongated shaft 85 of inserter 20is rotated so as to wrap the suture around the inserter. By way ofexample but not limitation, inserter 20 may be rotated threerevolutions. As this occurs, there can be some gathering of the slackbetween first anchor 10A and inserter 20 and/or there can be some payout of the suture stored inside the inserter. At this point, a secondanchor 10B is ejected from lumen 90 of inserter 20 so that second anchor10B sits on the far side of the meniscus. Inserter 20 is then withdrawnback through the meniscus. Then the suture is tensioned (e.g., withtension wheel 120) so that (i) the suture between anchors 10A and 10B isreduced, so as to close the tear in the meniscus, (ii) the winding inthe suture is pulled taut, and (iii) the suture is forced into narrowsection 50 of distal slot 40 and narrow section 65 or proximal slot 55.As a result, this approach provides both the aforementioned cleatingaction provided by capturing the suture within narrow section 50 ofdistal slot 40, and also a supplemental securing action provided by thesuture which has been wound on itself. In practice, it has been foundthat this dual effect provides approximately 75 Newtons of holdingstrength.

Thereafter, additional anchors may be provided as needed so as to closethe tear.

FIGS. 23 and 24 show an alternative construction for anchor 10. Moreparticularly, with the construction shown in FIGS. 23 and 24, the distaland proximal portion of elongated body 25 are cut back on the “top” ofthe anchor, and recess 75 is elongated relative to distal slot 40 andproximal slot 55.

Thus, the present invention provides a meniscal repair system whichcomprises a plurality of anchors that ride over a single suture strand,which can be singly deployed within the body, with each single anchoracting as an independent fixation point for the suture strand. Theability to lock the suture within each anchor (such as with the cleatingfeature provided for each anchor) provides the ability for each anchorto act as an independent fixation point for the suture strand.Furthermore, these independent fixation points allow the suture, runningfrom one anchor to the next anchor, to act as an independent suturestitch. Additionally, the entire contiguous repair construct consists ofmultiple independent suture stitches extending between multiple adjacentanchors, with the construct such that if one or more stitches aredamaged or become loose or disengaged from an anchor, the other suturestitches are unaffected. Also, the ability to individually tighten eachsuture stitch (i.e., the suture strand extending between adjacentanchors) by drawing the suture through the deployed anchor's lockingfeature permits the desired suture tension to be achieved.

The present invention provides the ability to position variable suturepatterns across the torn meniscus in a contiguous fashion.Significantly, the repairing construct can have more than two points offixation to the meniscus using a single strand of suture, and does notrequire any suture tying.

Also, the present invention provides the ability to remove an anchorfrom a deployed suture construct without disrupting previously-deployedanchors. This would be accomplished by sliding the dislodged implantalong the suture strand outside of the body and breaking or cutting theimplant without damaging the suture. The user can then continue todeliver subsequent implants from the same device to complete the repair.

And the present invention provides the ability to cut the suture strandafter two or more implants have been deployed into the body, and thensecure the deployed suture strand to the leading anchor in the inserter(e.g., by knotting) so that the user can continue to deploy subsequentunused anchors still residing within the inserter as part of the repairconstruct.

The present invention provides a gating mechanism for singly deployingeach anchor from the inserter, e.g., fin 80, slot 105 and projection106.

Furthermore, the present invention provides an approach for wrapping ortwisting the suture around the inserter prior to ejection of an anchorso as to form a suture loop around the suture emanating from the anchor,so that subsequent tightening of the suture through the anchor draws thewrapped suture loop towards the anchor and further secures the suture tothe anchor.

Modifications

It should be understood that many additional changes in the details,materials, steps and arrangements of parts, which have been hereindescribed and illustrated in order to explain the nature of the presentinvention, may be made by those skilled in the art while still remainingwithin the principles and scope of the invention.

What is claimed is:
 1. A system comprising: a suture; and at least oneanchor, said anchor comprising: an elongated cylindrical body having adistal end, a proximal end, a first side, a second side diametricallyopposed to the first side, a longitudinal axis extending between thedistal end and the proximal end, and a cylindrical outer surfaceradially offset from the longitudinal axis, the distal end having on thefirst side of the body a distal slot opening on the cylindrical outersurface of said body and extending from the distal end of said bodyproximally along the longitudinal axis of said body, and the proximalend having on the first side of the body a proximal slot opening on thecylindrical outer surface of said body and extending from the proximalend of said body distally along the longitudinal axis of said body, thedistal slot and the proximal slot extending only on the first side ofthe body; the distal slot comprising a wide section and a narrowsection, wherein the wide section is provided with a width such thatsaid suture is slidably accommodated therein, and the narrow section isprovided with a width such that said suture is bound therein, andfurther wherein said wide section is disposed distally of said narrowsection; wherein said body is adapted such that said suture is initiallydisposed within said wide section of the distal slot of said anchor andthe proximal slot of said anchor, such that said suture is slidablerelative to said anchor; and further wherein said body is adapted suchthat said suture is thereafter disposed within the narrow section of thedistal slot of the anchor in order to bind said suture to said body. 2.A system according to claim 1 comprising a plurality of anchors, andfurther wherein, for each of said anchors, said suture is initiallydisposed within said wide section of the distal slot and the proximalslot of said anchor, such that said suture is slidable relative to saidplurality of anchors.
 3. A system according to claim 1 comprising aplurality of said anchors, and further wherein, for each of saidanchors, the suture is thereafter disposed within said narrow section ofthe distal slot, whereby to bind the suture to the plurality of saidanchors.
 4. A system according to claim 3 wherein tension in the suturebetween each pair of said anchors is independent of tension in thesuture between every other pair of said anchors.
 5. A system accordingto claim 1 further comprising an inserter, wherein said insertercomprises a hollow elongated shaft provided with a sharp point disposedeccentric to a longitudinal axis of said hollow elongated shaft; andfurther wherein said suture and said at least one anchor are disposedwithin a lumen of said hollow elongated shaft.
 6. A system according toclaim 5 wherein said inserter further comprises a drive shaft movablydisposed within the lumen of said hollow elongated shaft, whereby toselectively eject said at least one anchor from the lumen of said hollowelongated shaft.
 7. A system according to claim 6 wherein said inserterfurther comprises an element for engaging said at least one anchormoving through said hollow elongated shaft and retarding movement ofsaid at least one anchor through the lumen of said hollow elongatedshaft.
 8. A system according to claim 7 wherein said at least one anchorcomprises a fin, wherein said hollow elongated shaft is provided with aslot for receiving said fin, and further wherein said element comprisesa projection into the slot.
 9. A system according to claim 5 whereinsaid inserter comprises a tensioning element for tensioning said suture.10. A system according claim 1 wherein the elongated body furthercomprises a recess, and further wherein the recess is diametricallyopposed to the distal slot and the proximal slot.
 11. An anchor forsecuring suture to tissue, the anchor comprising: an elongatedcylindrically shaped body having a distal end, a proximal end, alongitudinal axis extending between the distal end and the proximal endand a cylindrical outer surface radially offset from the longitudinalaxis, said body being adapted for disposition in a lumen of a deliveryneedle for repair of tissue, said body comprising: a first side having adistal slot opening on the cylindrical outer surface of the body andextending from the distal end of said body along the longitudinal axistoward the proximal end of said body, the distal slot extending only onthe first side of the body; the distal slot comprising a first sectionextending from adjacent the distal end of said body and a second sectionextending from the distal slot first section toward the proximal end ofsaid body and terminating in said body; the distal slot second sectionbeing narrower than the distal slot first section; said first sidehaving a proximal slot opening on the cylindrical outer surface of thebody and extending from the proximal end of said body along thelongitudinal axis toward the distal end of said body and terminating insaid body in alignment with and removed from an end of the distal slot,the proximal slot extending only on the first side of the body; theproximal slot comprising a first section extending from the proximal endof said body and a second section extending from the proximal slot firstsection and towards the distal slot and in alignment therewith; and arecess in a second side of the body diametrically opposed from the firstside of said body and extending from a point removed from the distal endof said body to a point removed from the proximal end of said body, saidrecess being in communication with the distal slot and the proximalslot; the anchor being adapted to receive a suture at the proximal slot,which suture is adapted to extend through the body and out the distalslot first section, and is selectively retained in the distal slotsecond section by a widthwise narrowness of the distal slot secondsection relative to a diameter of the suture.
 12. The anchor inaccordance with claim 11 wherein the proximal slot first section is ofgreater width than the proximal slot second section.
 13. An anchoraccording to claim 12 wherein the proximal slot second section has awidth such that the suture is slidably accommodated therein.
 14. Ananchor according to claim 11 wherein said recess is diametricallyopposed to said distal slot and the proximal slot.
 15. An anchoraccording to claim 14 wherein said recess is in communication with thefirst section of the distal slot, the second section of the distal slot,and the proximal slot.
 16. An anchor according to claim 11 wherein theelongated body is non-tubular.
 17. An anchor according to claim 11wherein the elongated body further comprises a fin disposed thereon andextending lengthwise of said body from said proximal end to proximatesaid recess.
 18. An anchor according to claim 17 wherein said fin isaligned with said recess.
 19. The anchor in accordance with claim 11wherein the distal slot and the proximal slot are in lengthwisealignment and the ends of the distal slot and the proximal slot arespaced from each other by a portion of said body.
 20. The anchor inaccordance with claim 19 and further comprising a fin disposed on saidsecond side of said body at said proximal end and extending to proximatesaid recess.
 21. The anchor in accordance with claim 20 wherein said finis configured and sized to slidably move along a groove in a tool shaft.22. The anchor in accordance with claim 11 wherein a wall portion ofsaid body is disposed between said distal slot second portion and saidproximal slot second portion and defines an internal wall of said body,and the suture is adapted to extend along the internal wall between saiddistal slot second portion and said proximal slot second portion.